Gonsette Kimberly, Tuna Turgay, Szegedi Laszlo L
Service d'Anesthésiologie-Réanimation, C.U.B. Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
Saudi J Anaesth. 2021 Jul-Sep;15(3):356-361. doi: 10.4103/sja.sja_54_21. Epub 2021 Jun 19.
The management of the robotic thoracic surgical patient requires the knowledge of minimally invasive surgery techniques involving the chest. Over the past decade, robotic-assisted thoracic surgery has grown, and, in the future, it will take an important place in the treatment of complex thoracic pathologies. The enhanced dexterity and three-dimensional visualization make it possible to do this in the small space of the thoracic cavity. Familiarity with the robotic surgical system by the anesthesiologists is mandatory. Management of a long period of one-lung ventilation with a left-sided double-lumen endotracheal tube or an independent bronchial blocker is required, along with flexible fiberoptic bronchoscopy techniques (best continuous monitoring). Correct patient positioning and prevention of complications such as eye or nerve or crashing injuries while the robotic system is used is mandatory. Recognition of the hemodynamic effects of carbon dioxide during insufflation in the chest is required. Cost is higher and outcome is not yet demonstrated to be better as compared to video-assisted thoracic surgery. The possibility for conversion to open thoracotomy should also be kept in mind. Teamwork is mandatory, as well as good communication between all the actors of the operating theatre.
机器人辅助胸外科手术患者的管理需要掌握涉及胸部的微创手术技术。在过去十年中，机器人辅助胸外科手术不断发展，并且在未来，它将在复杂胸科疾病的治疗中占据重要地位。增强的灵活性和三维可视化使得在胸腔的狭小空间内开展手术成为可能。麻醉医生必须熟悉机器人手术系统。需要使用左侧双腔气管导管或独立支气管封堵器进行长时间的单肺通气管理，同时还需掌握可弯曲纤维支气管镜技术（最好进行持续监测）。在使用机器人系统时，必须正确安置患者体位并预防诸如眼部、神经或碰撞损伤等并发症。需要认识到胸部充气过程中二氧化碳对血流动力学的影响。与电视辅助胸腔镜手术相比，其成本更高，且尚未证明疗效更佳。还应牢记转为开胸手术的可能性。团队协作必不可少，手术室所有人员之间的良好沟通也同样重要。
